LU-177

[Blair77]

If I'm reading this correctly could this drug control PC indefinently?

[PaulC2]

I don't read it as you do.

The key sentence from the excerpt you quoted is, "Ultimately, there could be a new treatment modality to improve symptomatic patients and/or prolong survival."

As with so many other therapies in the pipeline, it sets the bar low and hopes to cross it anyway. The bar is "improvement" in symptomatic patients (perhaps less pain, at least for a while) and/or to "prolong survival" (i.e., those who don't take it have a median-time-to-death of 3.4 months, whereas those who do take it have a have a median-time-to-death of 5.3 months). This is quite usual.

If the complete article contained some language that hinted at "durable remission" or the like, it was absent from the excerpt you quoted.

[MelaniePaul]

As you know, I have looked into this treatment for months and spoken to some doctors from Germany about it. You can't say whether or not it would fight prostate cancer so that it doesn't come back. It helps to shrink bone mets and perhaps lymph mets but this is not to say that they couldn't come back at a later stage. So it is a good treatment option, I think, and has very few side-effects, but it is like any of the others: only helping to prolong life.

Mel.

[Hidden in reply to MelaniePaul]

My life is prolonged by one day at a time.

[Neal-Snyder in reply to MelaniePaul]

Hi Mel,

And that's a good thing! Looking forward to hearing how well it serves Paul.

Best,

Neal

[rococo]

It states. It can be repeated in 8 wks intervals leading to continued tumor control. I don't see how you can become refractory to these targeted R.T.s, thus permanent control, but does this also target soft tissue as it is carried by psma?

[vandy69]

My Med Onc says this drug has been in trials since he was a Resident over 17 years ago, so he does not even consider it.

Best wishes. Never Give In.

[Hidden in reply to vandy69]

Lutium, a beta emitter, may have been in trials for a long time, but Actinium, an alpa emitter apparently, has not been. PSMA guided alpha emitter seems like a good idea in general.

Lutium is the current warhead in PRRT treatmet for neuro endocrine tumors. See university of iowa work, adapted from european practice.

[AlanLawrenson]

My brother aged 77 had his first Lu-177 injection in Sydney some months back. His PSA at the time was 9 which was controlled by Xtandi (enzalutamide). His PC had become castration resistant about 15 - 18 months ago. Whilst the Xtandi and an excellent diet and exercise regime were keeping the disease's progression at bay, there was no certainty that it would continue to do so long term.He also had cancer causing restrictions in his ureters thus reducing his kidney function and had mets in at least 30 places around the body, including lymph nodes.

He was not keen on chemo and had avoided it.

A number of clinical trials are underway in Australia to validate the safety and effectiveness of Lutetium -177 PSMA therapy. He was to late to join these trials. A private company (Theranostics) has obtained Governmental approval to treat patients in Australia. About 200 men have so far been thus treated. About 4 weeks after his first injection his PSA dropped to 6.4. A second injection at higher dose saw his PSA drop to 1.47 some weeks later. Last week his PSA was less than 1 and all pain was gone. His PET scan showed an absence of all but one met. This one was greatly reduced. He is due to have another PET scan in about 8 weeks.

His general condition has improved considerably. He told me that his result appear to be far better than the other men that were at the clinic whilst he was there. Why? Almost impossible to tell - more trials are needed. However, I might speculate that the PSMA therapy may have been assisted by the Xtandi. By the way, PSMA therapy does not work at all on about 15% of men probably due to lack of PSMA receptors on their PC cells.

I talk a little more about PSMA therapy in my ProstateTalk Newsletters at anabcofprostatecancer.com.au.

[Tonar in reply to AlanLawrenson]

Hi Alan,

You write:

"However, I might speculate that the PSMA therapy may have been assisted by the Xtandi."

Could I ask what makes you think that this was the case?

Cheers,

Tony

[petercraig2]

I went to Berlin in March 2017 for GA-68 PSMA PET CT scans when I had rising PSA after robotic surgery. Scan showed 3 small lymph node tumors in lower pelvic region. Had long conversation with two senior oncologists who said Lu-177 was not an option as my tumors were too small and lacked critical mass for Lu-177 to be of any use.

In addition they said that Lu-177 isn't a long treatment therapy but very effective at targeted tumors of sufficient size & density. They have been using Lu-177 as standard treatment there for years in conjunction with PSMA PET-CT scans to identify tumors very early in development.

All the staff and clinicians were very helpful and informative and I plan to return for PSMA scans following my six weeks of radiation which I stated yesterday.

Peter

[Lisa7739]

What does your PSA have to be at for a PMSA gallium 68 to show any tumors? I had a 2 mm positive surgical margin after radical prostatectomy. Surgical margin is a gleason 6. I have not had my psa levels checked as I just had surgery four weeks ago. Just wondering if I should get accommodations scheduled to go to Berlin for the pmsa testz

[Hazard]

I have a tumour right next to my rectum and no-one is prepared to either operate or radiate due to risk of rectum damage so I was put on ADT. We considered Lu177 as it is available in Australia as already noted by Alan, but upon investigation my specialist was advised that there was a high risk of leukemia down the track.

So on this advice, Lu177 is very much a last line of defence that will prolong life for very advanced cases but too dangerous at earlier stages.